Sr. Specialist, Claims & Fraud Operations

Job Description

Job Family: Business Operations

Responsible for the day-to-day operations of the company’s business units. Aims to deliver superior service to clients by driving and optimizing the effectiveness and efficiency of people, processes and technology thereby enhancing financial performance, increasing investment capacity, and managing risk. Builds the sustainable repeatable capabilities that support delivery of the highest standards of service and execution. Analyzes and reviews data tools, business processes and operational standards to execute service delivery. Evaluates and ensures that operations meet company objectives, business needs, service agreements and relevant requirements. Researches and monitors external landscape to identify developments and translate them into operational implications for the company.

Job Function: Business Operations

Responsible for the day-to-day operations of the company’s business units. Aims to deliver superior service to clients by driving and optimizing the effectiveness and efficiency of people, processes and technology thereby enhancing financial performance, increasing investment capacity, and managing risk. Builds the sustainable repeatable capabilities that support delivery of the highest standards of service and execution. Analyzes and reviews data tools, business processes and operational standards to execute service delivery. Evaluates and ensures that operations meet company objectives, business needs, service agreements and relevant requirements. Researches and monitors external landscape to identify developments and translate them into operational implications for the company.

Summary of Responsibilities:

The Specialist, Claims & Fraud Operations performs routine, analytical review of data and/or documentation which may include customer data and/or review for fraud/risk activities. Will be tasked with making decisions on disputed transactions and/or suspect activity flagged for investigative review. S/he performs other such duties as assigned including trouble shooting operational issues. The incumbent participates in projects requiring coordination with other teams. The Specialist, Claims & Fraud Operations manages competing priorities in an accurate and timely manner.

Essential Functions:

• Analyzes current fraud trends and provide input into rules and parameters.
• Develops and maintains Policy and Procedure Manuals.
• Develops registration & licensing documents, policy and procedure manuals, and other documentation as needed.
• Completes governmental reports such as SAR.
• Investigates fraud claims involving ACH, Pre-authorized drafts, altered check, forged endorsements, unauthorized third party transfers, elder fraud, identity theft or other operations fraud issues.
• Researches discrepancies, accumulate all necessary information and take appropriate action to stop, and where possible, prevent fraud and identity theft losses.
• Reviews daily reports for unauthorized share activity.
• Maintains case files and work with law enforcement agencies and internal departments.
• Enters fraud cases in the case management system.
• Reports suspicious activity as required by the Bank Secrecy Act.
• Assists in the preparation of filing bonded claims and un-bonded charge off recommendations.
• Conducts daily new business and member account and/or changed account review and due diligence actions in compliance with the USA Patriot Act Member Identification Program (MIP).

Other Functions:

• Other duties as assigned.

Requirements:

• Education –
  • H.S. Diploma
  • or equivalent work experience
• Experience –
  • 0-3 years of loss prevention, fraud, regulatory compliance and fraud prevention or security area experience, preferably in financial services.
• Skills & Abilities –
  • Working knowledge of loss and fraud detection/prevention principals, multiple fraud areas, compliance and regulatory issues related to the department and/or company.
  • Working knowledge of fraud systems such as Lexus Nexus, Targus, Tran Union TLO
  • Knowledge and experience with root cause analysis
  • Solid analytical, interpretive and problem solving skills
  • Ability to analyze diverse information and develop strategy recommendations
  • Excellent customer service and communication skills, both verbal and written
  • Excellent organization skills
  • Solid ability to multi-task
  • Solid knowledge of department computer applications and systems
  • Proficient in MS Office Applications

Competencies:

• Collaboration – Teamwork:
  • Foundational – Learning and Developing
    • Works effectively in team settings
    • Shows appreciation for others’ help and lends a hand when needed to complete shared tasks
• Execution – Accountability:
  • Foundational – Learning and Developing
    • Maintains professional behavior at all times in representing the company
    • Does all routine work accurately and on-time; is aware of own impact on others
• Influence – Two-way communication:
  • Foundational – Learning and Developing
    • Communicates clearly and precisely
    • Listens carefully and asks questions to clarify understanding
• Problem Solving – Problem Identification:
  • Foundational – Learning and Developing
    • Defines issues accurately and identifies the critical components
• Problem Solving – Resourcefulness:
  • Foundational – Learning and Developing
    • Accurately identifies resource requirements to solve basic problems
• Customer Focus – Issue Ownership:
  • Foundational – Learning and Developing
    • Responds promptly to customer inquiries
    • Takes responsibility for issues and, with assistance, works to find a solution
• Risk Management – Knowledge of Risk Management Policies, Regulations, Processes and Procedures:
  • Foundational – Learning and Developing
    • Learns about and diligently follows established risk management policies, processes and procedures
• Risk Business Acumen – Industry Acumen:
  • Foundational – Learning and Developing
    • Knows who the organization’s key customers and competitors are
    • Has basic understanding of financial services industry and how organizations operate

Working Conditions:

• Frequently: Minimal physical effort such as sitting, standing, and walking.
• Occasional moving and lifting of equipment and furniture is required to support onsite and offsite meeting setup and teardown.
• Physically capable of lifting up to fifty pounds, able to bend, kneel, climb ladders.

Employer’s Rights:

• This job description does not list all the duties of the job. You may be asked by your supervisors or managers to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description.
• The employer has the right to revise this job description at any time. This job description is not a contract for employment, and either you or the employer may terminate employment at any time, for any reason.